Sacramento, CA - On Friday, Dec. 14, U.S. District Court Judge Reed O’Connor ruled that the Affordable Care Act (ACA) is unconstitutional in the case Texas v. USA. The ruling notes that the individual mandate penalty – zeroed out by Congress one year ago – is so central to the ACA that without it, the entire ACA is unconstitutional.

NAMI California is closely following this ruling, which will be appealed, and may be overturned. As it stands, this ruling poses a direct threat to mental health care for millions of Californians. Without protections afforded under the ACA, we would see the clock turned back on parity and patient protections. Without the ACA:

Millions of individuals and families covered through Medicaid expansion, including people with mental illness, would lose their coverage.

Millions of individuals who purchase individual or small group health insurance plans would lose important protections—and could even lose their coverage. These plans would no longer be required to:

Cover preexisting conditions, like mental illness

Guarantee coverage to everyone who applies

Provide parity coverage for mental health and substance use conditions

Americans who have health insurance through their employer would

Lose their right to preventive services

Lose coverage of children to age 26

See lifetime and annual dollar limits of coverage reappear

NAMI California strongly supports the right of all individuals to access needed mental health care. In particular, parity and coverage for pre-existing conditions – two critical protections for ensuing quality mental health care and treatment – must be protected.

As of now, no one will lose their coverage or have patient protections stripped away from their health plan. The White House issued a statement regarding the ruling that read, “We expect this ruling will be appealed to the Supreme Court. Pending the appeal process, the law remains in place."

In response to concerns that confusion over the ruling may have deterred individuals from signing up for health insurance, Covered California, the state’s health care marketplace, has extended enrolling deadlines for individuals signing up for coverage. Anyone enrolling through Dec. 21 will see coverage start Jan. 1. Anyone enrolling between Dec. 22 and Jan. 15 will see their coverage start on Feb. 1.

NAMI California will continue to monitor this situation and support efforts to protect essential coverage and patient protections for individuals living with mental illness.

The California Department of Housing and Community Development is currently accepting competitive grant applications for the No Place Like Home Program. This post provides a short summary that outlines this application process and addresses some of the technical points of the application.

Structure of Funding

No Place Like Home (NPLH) funding will be allocated in 4 funding rounds, with one funding round being administered each year.

The Notice of Funding Availability (NOFA) for the 1st round was released in 2018, allocating $400 million. Funds will be awarded in June of 2019. Allocation amounts for subsequent rounds are still to be determined, with no estimates currently provided by the Department of Housing and Community Development (HCD). The number of applicants in the 1st round will dictate how rounds 2, 3, and 4 will be conducted.

Funding allocations per year are dependent on the interest and debt service rates which are still to be determined; however HCD anticipates needing to use the full $140 million allowed annually by statute for repayment (debt servicing) of the bonds issued to fund NPLH.

The deadline for submitting applications under the NOFA was extended to January 30, 2019.

Planning and Approval Process

NPLH competitive grant applications can be submitted as part of an MHSA county plan or a Continuum of Care program, or submitted independently.

HCD is the only body needed to approve independent NPLH competitive grant applications (grant application that are not part of existing MHSA 3-year plans or Continuum of Care plans).

No Board of Supervisors or local mental health board approvals are needed to approve the substantive provisions (services provided and structure of county NPLH plan) of independent NPLH plans. County Boards of Supervisor are still required to submit resolutions and other procedural documents to indicate that they are participating in NPLH.

HCD staff articulated that counties are given a wide range of discretion in formulating the process for creating their independent NPLH competitive grant applications. While the initial stakeholder input and final approval by HCD are required, counties are free to add any additional input or review processes. Additionally, competitive grant applications submitted as part of existing county MHSA plans must follow the Community Program Planning (CPP) requirements under the act.

Similarly, while counties must adhere to HCD deadlines to submit applications, individual timelines for developing independent plans are left to the county’s discretion.

Stakeholder Process

All NPLH applications have a mandatory provision to consult and obtain input from the following community stakeholder groups for plan development whether they are submitted independently or as part of an existing plan such as a county MHSA 3-year plan.

Required stakeholder groups:

County representatives with expertise from behavioral health, public health, probation/criminal justice, social services, and housing departments;

The local homeless Continuum of Care within the County;

Housing and Homeless services providers, especially those with experience providing housing or services to those who are Chronically Homeless;

County health plans, community clinics and health centers, and other health care providers, especially those implementing pilots or other programs that allow the County to use Medi-Cal or other non-MHSA funding to provide or enhance services provided to NPLH tenants, or to improve tracking of health outcomes in housing;

Public housing authorities and Representatives of family caregivers of persons living with serious mental illness.

The required stakeholder groups for the grant application appear very similar to the groups included in the Community Program Planning (CPP) process for MHSA county plans.

Beyond these requirements, counties are free to add additional stakeholder opportunities to independent plans or simply submit their plans to HCD for final approval after the initial required stakeholder input.

Important Considerations

HCD anticipates that it will rapidly be rolling out competitive grants with one round of funding per year over four year. HCD staff emphasized that the length of time to form NPLH applications is a critical issue. Integrating NPLH grant applications into MHSA 3-year plans offers thorough stakeholder opportunities; however, the process has a longer timeline and has more procedural approval requirements than an independent grant application. Additionally, there may be issues regarding the timing of submitting 3-year plans or annual updates that conflict with NPLH grant application deadlines. In light of these factors, it may be advised that counties submit NPLH independently of MHSA plans to ensure that all deadlines are met.

It is important to note that the deadline for submitting round 1 NOFA applications is January 30, 2019.

Adding NPLH grant applications to MHSA 3-year plans allows for multiple access points for stakeholder input and comments. The MHSA CPP process includes an initial input process for developing a draft of the 3-year MHSA plan, a 30 day subsequent comment period, mental health board public hearings, and through Board of Supervisors meetings.

In contrast, stand-alone NPLH competitive grant applications require extensive initial stakeholder input for the formation of the plan; however, the guidelines have no requirements for stakeholder input beyond this point.

It is also important to note that counties have a very large degree of discretion for the formation of NPLH applications, meaning that additional stakeholder opportunities can be offered by a county. The NPLH guidelines set the “floor” requirements, while counties can set their own “ceiling” of required input.

On Monday, October 29th 2018, 51 NAMI members throughout Los Angeles County from 10 affiliates gathered for the San Fernando Valley Regional Advocacy Meeting.

NAMI California, in collaboration with NAMI San Fernando Valley and NAMI Los Angeles County Council, coordinated the San Fernando Valley Regional Advocacy Meeting to provide members the opportunity to discuss priority issues in Los Angeles County. Regional Advocacy Meetings are designed to bring together members of the public, family members, community-based organizations, program leaders, and local NAMI affiliates to discuss priority issues. A big part of these meetings is working with Department of Mental Health staff to discuss the public planning and share ways members engage with that process.

From left to right: Deanna Robinson - Moderator, Brittney Weissman - Moderator, Dennis Murata - Service Area 8, Theion Perkins - Service Area 1, Lisa Wong - Service Area 3, La Tina Jackson - Service Area 2, Jacquelyn Wilcoxen - Service Area 5.

Working in partnership with the Los Angeles County Department of Mental Health, NAMI California invited all the Service Area Chiefs to a panel discussion with NAMI members. The Service Area Chiefs who participated in the panel discussion were:

Theion Perkins - Service Area 1

La Tina Jackson - Service Area 2

Lisa Wong - Service Area 3

Jacquelyn Wilcoxen - Service Area 5

Dennis Murata - Service Area 8

Los Angeles County Department of Mental Health Service Area Map

After a passionate and engaging panel discussion with the Service Area Chiefs, NAMI members took part in the NAMI Smarts training hosted by Deanna Robinson, NAMI San Fernando Valley Executive Director, and Jean Harris, NAMI Antelope Valley.

NAMI Smarts is a training developed to train NAMI members on how to engage policy makers in our priority issues. NAMI Smarts modules teach members how share their story with legislators, give an elevator speech, write letters of support/opposition, and other avenues of advocacy.

After having an opportunity to learn advocacy skills, members had a chance to break into groups and discuss local priority issues to move forward with in Los Angeles County. Our members discussed various needs in their communities ranging from the housing crisis to criminal justice reform.

This meeting will be the first in a series of advocacy discussions in Los Angeles. Thank you to Deanna Robinson, Susan Levi, and Brittney Weissman for their coordination of this successful event.

As the alarm rang at 5:00AM on a Monday morning, Claudia Haas woke up to get ready for the day ahead. As a member of NAMI San Francisco, Claudia knew how important it was to be a voice and advocate on behalf of individuals suffering from mental illness. She took the three hour Amtrak bus from San Francisco to Sacramento to attend NAMI California’s 2018 Fall Capitol Advocacy Day.

On September 24th, 2018, more than 45 NAMI California members met at the capitol to talk to legislative staff about NAMI priorities. Members traveled from more than 20 counties to discuss the importance of supporting access to mental health; ending the criminalization of mental illness; providing access to mental health services for K-12 & Young Adults; and investing in crisis services.

Attendees were passionate and excited to talk to staffers about mental health and to share their experiences. Attendees shared stories about supporting a family member living with mental illness, working with the mental health community, and living themselves with mental illness.

The timing of the advocacy day, after the end of the legislative session, meant that advocates were able to engage more deeply with legislative staffers. Many participants shared the fruitful results of 30 and 45 minute meetings at our afternoon debrief.

Thank you to all the advocates who joined us for a successful day. We look forward to connecting in support of advancing mental health goals in the upcoming year.

NAMI CA Vice President of Operations welcomes attendees to the 2018 Fall Capitol Advocacy Day